Fate of veterans' clinics in limbo as budget cutting looms

Sunday

Mar 3, 2013 at 2:00 AM

The Associated Press

WASHINGTON — A veterans' health clinic in Brick, N.J., is in such disrepair that when the snow gets heavy, patients have to go elsewhere for fear the roof might collapse. Another in San Antonio has extensive mildew and mold problems that could prove a health hazard for employees and patients in the coming years.

In Lake Charles, La., it's not the condition of a clinic but the lack of one. It's estimated that 6,000 veterans would enroll in VA health care if the community were to get a new clinic.

The Department of Veterans Affairs has cited these examples as it sought approval from Congress last year for a dozen new or expanded health clinics around the country.

Lawmakers anticipated that the cost for the current fiscal year would probably run into the tens of millions of dollars, but the estimate from the Congressional Budget Office came in at $1.2 billion. The nonpartisan CBO said that sound accounting principles require the full cost of the 20-year leases for the clinics be accounted for up front.

The huge jump in the clinics' price tag left lawmakers scrambling, and in the face of the budget-cutting climate on Capitol Hill, the VA request stalled. Now the agency is warning that unless lawmakers act, some currently operating clinics may have to close after their old leases expire and other long-planned expansions will not go forward.

Since the mid-1990s, the VA has turned to outpatient clinics as a way to bring health care closer to where veterans live. The department has opened 821 clinics to supplement the care provided at 152 medical centers. The clinics vary in size and services offered but virtually all provide primary care and mental health counseling. In most cases, the VA enters into a lease with private building owners, which gives the department flexibility to meet changes in demand down the road.

Any lease costing more than $1 million a year requires congressional approval. That's where the 12 proposed clinics come in. Lawmakers submitted the legislation to the Congressional Budget Office, which keeps score of how legislation fits with congressional spending targets.

When CBO took a closer look at the clinics, analysts determined that the leases generally involved the construction of new buildings that the VA would essentially finance through a 20-year lease. The CBO told lawmakers that the entire cost of the leases needed to be accounted for up front to show taxpayers the true cost associated with a 20-year obligation.

The Congressional Budget Office declined to discuss publicly the rational for its new treatment of VA leases.